Operative Management of Scheuermann’s Kyphosis in 71 Patients

Summary: A retrospective review of patients managed operatively for Scheuermann's kyphosis was conducted. Kyphosis correction was greater in patients treated with posterior only surgery; however, maintenance of correction was better in those who underwent combined AP procedures. Factors associated with the development of junctional kyphosis were explored.

Purpose: The purpose of this study was to evaluate correction of sagittal alignment, maintenance of correction, and occurrence of and etiological factors associated with junctional kyphosis in patients managed operatively for Scheuermann's kyphosis.

Methods: A retrospective multicenter review of 71 patients with Scheuermann's kyphosis treated operatively was conducted. A minimum 24 months follow-up was required. Kyphosis, lordosis, C7 sagittal plumbline, apical translation, junctional sagittal alignment, and pelvic incidence were assessed amongst other radiographic parameters. The incidence of junctional kyphosis and its relationship to the above parameters and to fusion levels were assessed.

Results: Of the 71 patients, 37 underwent combined AP procedures (group 1) and 34 had posterior surgery only (group 2). Mean age was 16.5 years. Overall, the greatest Cobb kyphosis of 78° was corrected to 51.6° at follow-up. Pre-operative kyphosis was 83.0° and 73.2° for groups 1 and 2, respectively (p10° occurred in 24 (33.8%) and 6 (8.5%), respectively. The development of a proximal junctional kyphosis correlated directly with increasing pelvic incidence, only. Pelvic incidence correlated directly with lumbar lordosis but not kyphosis. Four complications occurred in 4 patients including posterior wound infection, distal and proximal junctional kyphosis, and pseudarthrosis all requiring reoperation.

Conclusions: This is the largest reported series of Scheuermann's kyphosis treated operatively to our knowledge. A high rate of junctional kyphosis, especially at the proximal end, is associated with surgery for Scheuermann's kyphosis using current techniques. Proximal junctional kyphosis is associated with increased pelvic incidence. Loss of correction is less in patients undergoing combined AP surgery. Pelvic incidence correlates directly with lordosis but not kyphosis suggesting that these parameters are not causative of Scheuermann's kyphosis.